If you’re facing issues with your insurance provider, such as a denied claim, a disagreement over policy terms, a delay in claim settlement, or concerns about miss-selling, follow these guidelines to lodge complaints against the insurance companies:
Step 1: Internal Grievance Redressal Mechanism
The initial step is to engage with the insurance company’s internal grievance redressal mechanism. Each insurer maintains a dedicated Grievance Redressal Cell.
- Identification of Contact Information: Locate the contact details (email or phone number) of the Grievance Redressal Officer for your insurer on their website or policy documentation.
- Communication of Grievance: Clearly articulate your grievance in writing or verbally, ensuring meticulous documentation of the complaint reference number provided by the company.
- Regulatory Timeline: The insurer is obligated to respond to your complaint within a stipulated timeframe, typically 30 days.
Step 2: Bima Bharosa, IRDAI:
As the regulatory authority for the insurance sector, the Insurance Regulatory and Development Authority of India (IRDAI) entertains complaints through its online portal (Bima Bharosa), telephone, or email.
- Bima Bharosa: https://bimabharosa.irdai.gov.in/
- Toll-free numbers: 18004254732, 155255
- Email: complaints@irdai.gov.in
- Official Address: Consumer Affairs Department – Grievance Redressal Cell, IRDAI, Sy. No.115/1, Financial District, Nanakramguda, Gachibowli, Hyderabad – 500032.
Additionally, you may also file your insurance complaints through National Consumer Helpline (NCH).
Step 3: Escalation to the Insurance Ombudsman
If the insurer’s response proves unsatisfactory or fails to resolve the matter within 30 days, policyholders may lodge a grievance against the insurance company to the Insurance Ombudsman. This autonomous entity functions as an impartial quasi-judicial body for insurance-related complaints.
Procedure for online complaint filing to Insurance Ombudsman:
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Access the Grievance Redressal Portal: Visit the CIOINS portal to open the complaint form (cioins.co.in/), a centralized platform for registering complaints against insurers.
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Account Registration: Create an account on the grievance portal, providing your personal details and policy information.
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Complaint Submission:
- Identify the relevant insurance company.
- Select the appropriate complaint category (e.g., claim rejection, mis-selling).
- Provide a comprehensive description of your grievance, supported by pertinent documentation (policy copy, correspondence with the insurer, etc.).
- Formally submit the complaint.
You can also write to the head office of the Insurance Ombudsman or its regional offices.
Head Office, Executive Council of Insurers:
- Address: Insurance Ombudsman, 3rd Floor, Jeevan Seva Annexe, S. V. Road, Santacruz (W), Mumbai – 400 054.
- Phone: 02226106889, 02226106671
- Fax: 02226106949
- E-mail: inscoun@ecoi.co.in
For more information, read this article: How to file complaints to Insurance Ombudsman?
Consumer Courts:
For claims exceeding ₹20 lakhs, policyholders may approach the district, state, or national consumer forums.
You can file an insurance complaint against the insurer to the consumer court through the E-DAAKHIL portal.
Please remember:
- Articulate your grievance clearly and concisely, incorporating relevant details (policy number, date of incident, etc.).
- Furnish copies of all pertinent documents to bolster your case.
- Diligently maintain records of all communication with the insurer and the ombudsman.
Pro Tips:
- Comprehension of Key Terms: Thoroughly understand terms such as “premium,” “deductible,” “sum insured,” “exclusion,” and “grace period.”
- Coverage Assessment: Verify that the policy provides adequate coverage for the desired risks.
- Scrutiny of Exclusions: Pay careful attention to policy exclusions.
- Thorough Reading: Do not overlook the fine print, as it often contains critical information.
- Clarification: Seek clarification from the insurer or an agent regarding any ambiguities prior to policy acquisition.
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